Rosh Internal Medicine Boost Practice Exam

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A patient develops tachycardia and diaphoresis shortly after a benzathine penicillin injection. What is the best treatment?

Ceftriaxone
Diphenhydramine
Dobutamine
Ibuprofen

The correct answer is: Ibuprofen

In the context of a patient who develops tachycardia and diaphoresis following a benzathine penicillin injection, the best treatment option is ibuprofen. The symptoms described may suggest a hypersensitivity reaction or an anaphylactic response to the medication. In such cases, supportive care is critical, which includes managing fever or discomfort that can occur due to the reaction. Ibuprofen, being a nonsteroidal anti-inflammatory drug (NSAID), can help alleviate pain and reduce inflammation, contributing to comfort for the patient experiencing these symptoms. While antihistamines like diphenhydramine may also be useful in managing allergic reactions, the presence of more systemic symptoms such as tachycardia warrants a broader symptomatic management plan, which ibuprofen can support. Ceftriaxone and dobutamine are not appropriate in this context. Ceftriaxone does not treat the reaction to the penicillin, and dobutamine is primarily used for heart failure and is not indicated for managing an allergic reaction. Thus, in this situation, ibuprofen is the most suitable option for symptom relief following the administration of benzathine penicillin.